Severe acute malnutrition remains a major killer of children under five years of age. Until recently, treatment has been restricted to facility-based approaches, greatly limiting its coverage and impact. New evidence suggests, however, that large
numbers of children with severe acute malnutrition can be treated in their communities without being admitted to a health facility or a therapeutic feeding centre.

The community-based approach involves timely detection of severe acute malnutrition in the community and provision of treatment for those without medical complications with ready-to-use therapeutic foods or other nutrient-dense foods at home. If properly combined with a facility-based approach for those malnourished children with medical complications and implemented on a large scale, community-based management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children.

Nearly 20 million children under five suffer from severe acute malnutrition

Severe acute malnutrition is defined by a very low weight for height (below -3 z scores1 of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema. In children aged 6–59 months, an arm circumference less than 110 mm is also indicative of severe acute malnutrition. Globally, it is estimated that there are nearly 20 million children who are severely acutely malnourished.2 Most of them live in south Asia and in sub-Saharan Africa.

Severe acute malnutrition contributes to 1 million child deaths every year

Using existing studies of case fatality rates in several countries, WHO has extrapolated mortality rates of children suffering from severe acute malnutrition. The mortality rates listed in the table at right reflect a 5–20 times higher risk of death
compared to well-nourished children. Severe acute malnutrition can be a direct cause of child death, or it can act as an indirect cause by dramatically increasing the case fatality rate in children suffering from such common childhood illnesses as diarrhoea
and pneumonia. Current estimates suggest that about 1 million children die every year from severe acute malnutrition.3

The large burden of child mortality due to severe acute malnutrition remains largely absent from the international health agenda, and few countries, even in high prevalence areas, have specific national policies aimed at addressing it comprehensively. With the addition of communitybased management to the existing facility-based approach, much more can now be done to address
this important cause of child mortality.